diabetes insipidus

1. NAME:Rudradeep Hazra
Stream-Bachelor of pharmacy (2nd sem)
Roll no -19301918060.

2.  Diabetes insipidus (DI) is
a condition characterized by large
amounts of dilute urine and increased
thirst.The amount of urine produced
can be nearly 20 liters per
day. Reduction of fluid has little effect
on the concentration of the urine.
 Complications may
include dehydration or seizures.

3. CENTRAL DIABETES
INSIPIDUS
 Central DI has many
possible causes. According
to the literature, the
principal causes of central
DI and their oft-cited
approximate frequencies
are as follows:
 Idiopathic - 30%
 Malignant or benign tumors
of the brain or pituitary -
25%
 Cranial surgery - 20%
 Head trauma - 16%

4. NEPHROGENIC DIABETES
INSIPIDUS
 Nephrogenic diabetes
insipidus is due to the
inability of the kidney to
respond normally to
vasopressin.
DIPSOGENIC DIABETES
INSIPIDUS
 Dipsogenic DI or primary
polydipsia results from
excessive intake of fluids
as opposed to deficiency
of arginine vasopressin.
It may be due to a defect
or damage to the thirst
mechanism, located in
the hypothalamus; or
due to mental illness.
Treatment with
desmopressin may lead
to water intoxication.

5. GESTATIONAL DIABETES INSIPIDUS
 Gestational DI occurs only during pregnancy and the
postpartum period. During pregnancy, women produce
vasopressinase in the placenta, which breaks down
antidiuretic hormone (ADH). Gestational DI is thought to
occur with excessive production and/or impaired clearance
of vasopressinase.
 Diabetes insipidus is also associated with some serious
diseases of pregnancy, including pre-eclampsia, HELLP
syndrome and acute fatty liver of pregnancy. It is
important to consider these diseases if a woman presents
with diabetes insipidus in pregnancy, because their
treatments require delivery of the baby before the disease
will improve. Failure to treat these diseases promptly can
lead to maternal or perinatal mortality.

6.  Excessive urination and extreme thirst and increased fluid intake(especially
for cold water and ice or ice water) are typical for DI. The symptoms of
excessive urination and extreme thirst are similar to what is seen in
untreated diabetes mellitus, with the distinction that the urine does not
contain glucose.
 Signs of dehydration may also appear in some individuals, since the body
cannot conserve much (if any) of the water it takes in.
 Extreme urination continues throughout the day and the night.
 In children, DI can interfere with appetite, eating, weight gain, and growth.
They may present with fever, vomiting, or diarrhea. However, there is a
continuous risk of dehydration and loss of potassium that may lead
to hypokalemia.

7. Central
 Central DI and gestational DI respond
to desmopressin which is given as intranasal
or oral tablets. Carbamazepine, an
anticonvulsive medication, has also had some
success in this type of DI. Also, gestational DI
tends to abate on its own four to six weeks
following labor, though some women may
develop it again in subsequent pregnancies.
In dipsogenic DI, desmopressin is not usually
an option.

8. Nephrogenic.
 A thiazide diuretic, such
as chlorthalidone or hydrochlorothiazide, can be used
to create mild hypovolemia which encourages salt
and water uptake in proximal tubule and thus
improve nephrogenic diabetes
insipidus. Amiloride has additional benefit of
blocking Na uptake. Thiazide diuretics are sometimes
combined with amiloride to
prevent hypokalemia caused by the thiazides.
 The thiazide diuretics will decrease distal convoluted
tubule reabsorption of sodium and water, thereby
causing diuresis. This decreases plasma volume, thus
lowering the glomerular filtration rateand enhancing
the absorption of sodium and water in the proximal
nephron. Less fluid reaches the distal nephron, so
overall fluid conservation is obtained.

9.  Lithium-induced nephrogenic DI may be effectively
managed with the administration of amiloride, a
potassium-sparing diuretic often used in
conjunction with thiazide or loop diuretics.
Clinicians have been aware of lithium toxicity for
many years, and traditionally have administered
thiazide diuretics for lithium-induced polyuria and
nephrogenic diabetes insipidus. However,
amiloride has recently been shown to be a
successful treatment for this condition.

10.  I am very much thankful to my professor to
give me such a wonderful topic to work on.
 Reference –Internet,Human anatomy by
Tortura,Human anatomy and physiology by
ross and wilson.